Healthcare Provider Details

I. General information

NPI: 1972797421
Provider Name (Legal Business Name): DENISE A. WOODY-GROSS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 LOUIS PASTEUR STE 410
SAN ANTONIO TX
78229-3419
US

IV. Provider business mailing address

PO BOX 780836
SAN ANTONIO TX
78278-0836
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-0620
  • Fax: 210-615-8027
Mailing address:
  • Phone: 210-593-0620
  • Fax: 210-615-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberJ8844
License Number StateTX

VIII. Authorized Official

Name: DR. DENISE A. WOODY-GROSS
Title or Position: M.D.
Credential: M.D.
Phone: 210-593-0620